Tiny Doses

Oral immunotherapy (OIT) for life threatening food allergies starts with ingesting tiny doses of the allergen. Tiny doses so the immune system lets it go undetected. This is because if the dose is detected it will trigger an anaphylactic reaction which can only be stopped with a shot of life saving epinephrine.

We continue with daily dosing.

Sahil is on the first updose of the peanut OIT protocol. So after he eats dinner I use a syringe to measure 1 mL of the diluted peanut suspension (0.5 mg/mL) and release it under his tongue; he holds it there for a minute and then swallows. He usually eats some applesauce after the dose because he has noticed it prevents a stomach ache which he was experiencing when he did not eat after the dose. Since we increased from the starting dose to the current dose he has occasionally complained of an acidic taste in his mouth after eating. And once in a while he coughs a bit while eating – he says it is like something is stuck in his throat. I will mention it to the doctor. I have read that some patients need to take an antacid during OIT to prevent symptoms of reflux. I wonder if this is what he is experiencing.

Jaya is on the first updose of the milk OIT protocol. For her it’s 2 drops of diluted milk placed under her tongue. She holds it for a minute and swallows. She sometimes complains of stinging where I place the drops but it only lasts a few seconds.

For both of them there is a two hour rest and observation period after the dose. This is to ensure that their core body temperature does not become elevated as this could trigger a reaction.

So far, they are adhering to the protocol and observing the rest period.